title: Early enteral nutrition in patients with hemodynamic failure following cardiac surgery.
abstract: BACKGROUND
  Enteral nutrition (EN) is controversial in patients with circulatory compromise. This study assesses the feasibility and safety of EN given early after cardiac surgery in patients with hemodynamic failure.
  
  
  METHODS
  Prospective observational study conducted in a surgical intensive care unit (ICU) of a tertiary hospital over 17 months.
  
  
  METHODS
  Cardiac surgery patients with hemodynamic failure (dependence on 2 or more vasoactive drugs and/or mechanical circulatory support) requiring more than 24 hours of mechanical ventilation. Variables Examined: Descriptive data, daily hemodynamic data, and variables related to the efficacy and safety of EN. EN was performed according to our EN protocol.
  
  
  RESULTS
  Of 642 patients admitted to the ICU, 37 (5.8%) met the inclusion criteria. Of these, 11 (29.7%) required mechanical circulatory support, and 25 (68.0%) met the criteria for early multiorgan dysfunction. Mortality was 13.5%. Mean EN duration was 12.3 days (95% confidence interval [CI], 9.6-15.0). The mean EN diet volume delivered/patient/d was 1199 mL (95% CI, 1118.7-1278.8), and mean EN energy delivered/patient/d was 1228.4 kcal (95% CI, 1145.8-1311). The set energy target was achieved in 15 patients (40.4%). The most common EN-related complication was constipation. No case of mesenteric ischemia was detected.
  
  
  CONCLUSIONS
  Our findings indicate that early EN is feasible in this type of patients and not associated with serious complications. However, it is difficult to attain an appropriate energy target by EN alone. These observations point to a need for monitoring of daily energy delivery and balance, as well as careful monitoring of warning signs of intestinal ischemia.
authors.affiliation: Intensive Care Medicine Service makalyconru@hotmail.com.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Flordelís Lasierra
authors.affiliation: Intensive Care Medicine Service.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Pérez-Vela
authors.affiliation: Intensive Care Medicine Service.
authors.forename: Luis Daniel
authors.initials: LD
authors.lastname: Umezawa Makikado
authors.affiliation: Intensive Care Medicine Service.
authors.forename: Enrique
authors.initials: E
authors.lastname: Torres Sánchez
authors.affiliation: Intensive Care Medicine Service.
authors.forename: Lara
authors.initials: L
authors.lastname: Colino Gómez
authors.affiliation: Intensive Care Medicine Service.
authors.forename: Borja
authors.initials: B
authors.lastname: Maroto Rodríguez
authors.affiliation: Intensive Care Medicine Service.
authors.forename: Primitivo
authors.initials: P
authors.lastname: Arribas López
authors.affiliation: Clinical Research Support Unit, Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: Agustín
authors.initials: A
authors.lastname: Gómez de la Cámara
authors.affiliation: Intensive Care Medicine Service.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Montejo González
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D003248:Constipation / Q000209:etiology; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness / Q000451:nursing; D002149:Energy Intake; D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006331:Heart Diseases / Q000150:complications* / Q000601:surgery; D006439:Hemodynamics; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects / Q000451:nursing*; D016896:Treatment Outcome
keywords: cardiac disease; critical care; enteral nutrition